Which antihypertensive drug is contraindicated in hyperkalemia?
Nov 07, 2025
Source: Cainiu Health
Dr. Tian Hongbo
Introduction
Antihypertensive drugs contraindicated in patients with hyperkalemia generally include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, and spironolactone. ACE inhibitors suppress the activity of angiotensin-converting enzyme, thereby reducing aldosterone secretion. Since aldosterone promotes potassium excretion, decreased aldosterone secretion leads to elevated serum potassium levels, which may exacerbate hyperkalemia.
Antihypertensive drugs contraindicated in patients with hyperkalemia generally include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), spironolactone, triamterene, and eplerenone. Detailed explanations are as follows:
1. Angiotensin-Converting Enzyme (ACE) Inhibitors: These drugs inhibit the activity of angiotensin-converting enzyme, thereby reducing aldosterone secretion. Aldosterone promotes potassium excretion; when its secretion is reduced, serum potassium levels rise, worsening hyperkalemia. Therefore, ACE inhibitors are strictly contraindicated in patients with hyperkalemia.
2. Angiotensin II Receptor Blockers (ARBs): These agents lower blood pressure by blocking angiotensin II receptors, but they also impair aldosterone release, leading to decreased potassium excretion and elevated serum potassium levels. Their use in patients with hyperkalemia may cause severe electrolyte disturbances and should be avoided.
3. Spironolactone: A potassium-sparing diuretic, spironolactone lowers blood pressure by competitively antagonizing aldosterone, reducing sodium reabsorption and potassium excretion. Due to its inherent potassium-retaining effect, its use in hyperkalemic patients further increases serum potassium levels and the risk of arrhythmias, making it absolutely contraindicated.
4. Triamterene: A non-selective potassium-sparing diuretic that directly inhibits sodium reabsorption in the distal renal tubules while simultaneously reducing potassium secretion. The drug itself can elevate serum potassium levels, which conflicts with the condition of hyperkalemia; therefore, it is contraindicated in these patients.
5. Eplerenone: A selective aldosterone receptor antagonist, it has both antihypertensive and potassium-sparing effects. By blocking the action of aldosterone on the kidneys, it reduces potassium excretion. Its use in patients with hyperkalemia exacerbates abnormal potassium levels and must be strictly avoided.
When selecting antihypertensive medications, patients with hyperkalemia should inform their physicians of their electrolyte status so that a safe treatment plan can be determined. If symptoms such as muscle weakness or palpitations occur, prompt medical evaluation for potassium abnormalities is necessary.
